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HomeMy WebLinkAbout16-148IDENTIFICATION NOJ ( jo � JqP) 1 1 (Office Use Only) �4 r"III Ott94 MIS®r�� CITY OF IOWA CITY APPLICATION FOR TAXICAB/ MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) 410 East Washington Street lova cite, 1mva 52240-1826 Failure to complete the "required" information will result in denial of the ai!M ication (3 19) 356-5040 Q19) 3S6-5497 FAX First /� Middle ast 1. Name (REQUIRED) 1�/•�i31Jct iG j;v5t-%fA 2. Address (REQUIRED) o� yo2� ��Vrg-G ] )2(7 API � u 3. Contact Information (REQUIRED) Email.Cell Phone: Q/ (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) �ZO 21 b. Taxicab Business Name (REQUIRED) 0 Z /PQ 30 (,VA �Al 5. Prior experience in transportation of passengers: I v J t v y 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other kjy 7. Have you been arrested / charged with any traffic offenses in the last five years? NO Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? t V Type of offense W here When r~� 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the_nanne(sL )T) 11 ly tt DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE: CERTIFIED r..-=•, DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW ` d You must apply for an individual Department of Criminal Investigation Report (form available u(ion request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I her certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number N , A r4 q 2!5 O issued on 1'a-, expiring on Q 1 -215 -24P2)1 understand that if I falsely answer any questions in this application, that this application may be denied. I agree that in making this application, I consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion, to examine any and all records and documents relating to this application, and I further agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) a Signature of Applicant Date /© STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by %16`V—r b�a�.�y �,(o:ki.- on this I(a day of Notapy,Plublic in and for the State of Iowa I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Cod ). Expiration date of Driver's license big zo 202 j l7g1 L7 I t< Signaturi51cf Po)ice hief or designee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. ign re of City Clerk or designee a rate/,/ rn Office Use Only w Approved application DCI repot ? State certified driving record Website update aErt.1TA IDRIVBADGEAPPL92014amendedDOC 0712016 Cj10v)J'4A00T wvwv.oVvadot.gov SMARTER f SIMPLER I CUSTOMER DRIVEN Inquiry Date: Customer Name: Address 8/4/2016 6514015 Page 1 of 2 Office of Driver Services PO Box 9204 i Des Moines. IA 50306-9204 Phone: 515-244-91241800-582-11211 Pa;: 515-239-1837 www to•wadol-gov Certified Abstract of Driving Record DL/ID #: IIIAM9250 (IA) CDL Permit Class: None Class: D Babiker, Babiker Boshra Audit #: 2425 BARTELT RD APT Issue Date: 2D City/State: IOWA CITY, IA 522462709 Mailing 2425 BARTELT RD APT Address: 2D Mailing IOWA CITY, IA City/State: 522462709 Date of 9/20/1963 Birth: Sex: M 1151075 07/14/2016 Expiration 09/20/2021 Date: Endorsements: 3 CDL Permit Issue None Date: COL Permit None Expiration Date: Restriction None CDL Permit None Endorsements: CDL Permit CDL Permit None Restrictions: ID Status: None Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Supplement: CDL Permit ELG Status: CDL Cert Status: None CDL Med Status: None History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 07/19/2016 1931544 IA Name: Babiker, Babiker Boshra DL/ID: 111AM9250 Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this is a true and accurate copy of an official record currently in the custody of said office, and that I have been authorized by the Director of the Iowa Department of Transportation to so certify, rv•a u In witness whereof, I have caused my signature and the seal of the Department to be set upon this docu rr(F[t, at Ankeny, Iowa this date: 00. 8/4/2016 _.�. IOWA '''��°�,, �'I,,, IVF.N�d IOffIowaDepartment of eof Driver eiTransportation 8/4/2016 Aug. 5. 2016 4'.25PM D,v 0f Criminal Investigation Pia 9908 P. 7 Fr - , 61or ,. _ -,_ _---.-, aeioai �o-Ig t6:�-.. JGoi. ..�ovoos qTATE Reqne7t�,t Form F 1 DCJ Accovnf Nonilbrr', _ �� C, (if applit',i ) TO; Ivwa Division (If CsinunaI Inve,,tinaiiaf) ^support Operations Bureau, 1" Floor 215 E, 71" Stree( Iles Monies, lova ;0319 (515) 77.5-6066 (515)i25-6080 Vax I mi -rffmreu5Y ie an ln%va Criminal iiistnn, Rr.nnrd Check no - hrorn; Ci�uSfowaCity _-_-„-,- Cfty Clerk's Office _410 E. Washington 5tI_ac( ._---- fovea Cilv. N, 52240 Phonc: 319-856-509N Ba)i: 319-356-5497 Last N3Nne [,nmo tu,y) Flr.0 1,42me (1nandatory) dlliddle )dame (lee GnnFnCieCd) �- rjti A Date of Birth (mandalory) Lender manda(ory) Social Security Number (acommurded 41 I ��7 ��C7� Male ❑b'emafe C'\JT� .r��' �` � z Waiver Xr fovrnaf on: Without a signed waiver from the subject of the request, a complete criminal history record may not he releasable, per Code of Iowa, Chapter 6922. For coin Not criminal history record information, as allowed bylaw, always obtain a waiver signature from the subject of the request. Waiver Mease: I hereby give permission for the above roqucstiug othcisl to condun Itislary record check wish the Division of Criminal Invcgigadah (DCI). Any criminal history dela concerning me Thal Is mBi O-Mned by the DI)CI rn ssybt-Wq 911owtd by ln,v Waiver Signahtre: As of�`� 1� � , a starch of the provided name and date of birth reveal WA No Iowa C'riulinal History Record fowid with DCI lov`,a Crinlinat History Record attached, DCl #� DCI initials___ DCI -77 (08/25110) Received Time Aug. 3, 2016 2:53PM Bio, 0860 (OCl nsc oily) LJr''y'.'t:1 41 N '"ter